In June, I had the privilege of presenting at the International Conference on Clinical Ethics Consultation (ICCEC) in Oxford, UK. The conference brings together clinicians, philosophers, social workers, and others who work in clinical ethics to discuss new developments in the field, ideas for improving ethics services, and obstacles to providing excellent health care all over the world.

I led a panel discussion called "Moral Expertise from International Perspectives," alongside Jennifer Flynn from St. John's Canada and SallaSaxén from Tampere, Finland.

My contribution to the panel was an attempt to demythologize the concept of moral expertise. Many scholars worry that moral expertise implies special access to a metaphysical realm, a claim to decisional authority that trumps even expert judgment in other fields, or to make completely unbiased judgments.

However, theoretical and empirical evidence suggests that no kind of expertise has these implications and, thus, there is no reason to think moral expertise should imply them. Whether moral expertise actually exists or is widely achievable are different questions. But if moral expertise is possible, there are reasons to think it would look like other types of expertise.

I am excited to announce that my anthology with Laura Guidry-Grimes on moral expertise is scheduled to be published at the end of July!

This collection includes discussions of both theoretical and applied issues related to moral expertise, epistemic authority, clinical ethics consultation, ethics as a profession, and moral decision-making.

https://www.springer.com/us/book/9783319927589

1 IntroductionJamie Carlin Watson and Laura Guidry-Grimes

Part I Theoretical Perspectives

2 Moral Expertise: A Comparative Philosophical ApproachDennis Arjo

3 Moral Expertise: How to Get It and What to Do With ItChristopher Meyers

I recently had the pleasure of talking with Dr. Chris Richardson (Young Harris College) about Winning Votes by Abusing Reason. It's a long interview, but it gets at some of the more nuanced points in the book, and it highlights some of the challenges of moving forward from my conclusion. Click the image below to hear the interview, and also check out Chris's other interviews with Nicholas P. Greco and Hans Arthur Skott-Myhre.

The year is off at a gallop. I have a number of papers in the works on moral expertise, I am continuing to develop moral distress curriculum for MedStar Washington Hospital Center, and I am co-editing a book on moral expertise for Springer with clinical ethicist Laura Guidry-Grimes. But most recently, I wrote a review of Donald Joralemon's Mortal Dilemmas: The Troubled Landscape of Death in America for Metapsychology Online Reviews.

Joralemon explores dilemmas that arise in five end-of-life challenges: assisted dying, uncertain mental states, the definition of death, the role of grief, and memorialization. My favorite aspect of the book is Joralemon's nuanced response to the idea that the U.S. is a death-denying culture. The increasing "medicalization" of the dying process has pushed death out of public view and into intensive care units, long-term care facilities, and rehab centers. And time constraints at work now prevent us from spending extensive time with our dying loved ones. All this conspires to suggest that Americans are just looking for ways to stop thinking about death, to avoid it until we can't help it. But Joralemon argues that this is an overly simplistic conclusion. Many American sub-cultures, such as those belonging to some Mexican Americans and Jewish groups, maintain elaborate rituals to honor the dead or dying loved one. Further, the conclusion that Americans deny death ignores an important change in the relationship between biological death and social death—the ritual and emotional behaviors we engage in to come to terms with the separation caused by biological death.

Before contemporary medicine allowed us the ability to prolong life and diagnose terminal diseases, we could not start the process of separation from our loved one (social death) until the loved one had died (biological death). But shifting medical and economic conditions now force us to start the social dying process earlier, before biological death. We begin to move on while our dying loved ones are still alive. This creates new tensions in the dying process, and requires both the dying and the non-dying to take a greater responsibility in the emotional and relational aspects of dying. But rather than denying death, it simply forces us to respond to death differently. It also empowers the dying loved one to exert greater control over the social--and increasingly, the biological--process of dying.

As you'll see in the full review, my biggest complaint is Joralemon's lack of engagement with philosophical bioethics. Though he does a nice job elucidating the legal, medical, and political dimensions of these debates, he does not acknowledge the enormous contributions from philosophers. While this lacuna might have been motivated by intellectual humility, avoiding literature he doesn't feel qualified to address, his discussions reveal a lack even of familiarity with the philosophical contributions, and this influences his conclusions in non-trivial ways.

On Thursday, December 1st, I had the pleasure of talking with D.C. radio host Jamila Bey (WPFW-FM. 89.3 FM) about my new book, Winning Votes by Abusing Reason: Responsible Belief and Political Rhetoric. We discussed the problem of voter ignorance, George Carlin, the last "honest" political conversation we've had in the U.S., and what hope there might be for the future of our political climate.

She asked what I thought about the resistance to reliable information in political debates, and I said that, while some people attribute it to an attitude of "anti-expertise," I think this is not quite correct. People are happy to rely on sources they take to be reliable--they trust people who purport to be experts, they defer judgment to people they think have relevant information. The problem is that people choose their "experts" poorly. They defer judgment but to biased and unreliable sources that give the appearance of expertise. If I am right about this, the problem is not anti-expertise but "skewed expertise." We attribute expertise when we should not.

I also said that I think voter ignorance is only half the problem facing democracy. Though we don't know much and don't reason well about it, we are also prevented from participating in political machinery that might help adjust policy to accommodate this fact. Now, not having access to political machinery might not be a problem if, as many government officials thought when enacting legislation that excludes us, government officials were in a better position to make those decisions for us. Unfortunately, politicians are subject to the same biases and nefarious incentives as the rest of us. And preventing access to participation keeps the cost of poor beliefs very low, incentivizing the sort of bombastic political ideologies that are now raging around us.

As for hope, I said something along the lines of what I conclude in the book: those of us who recognize this problem have an obligation to put our belief-forming efforts into contexts and claims that provide high feedback and high value. This typically means becoming more involved in local and community initiatives.

I am grateful for the opportunity to appear on Jamila's show, and I look forward to hearing what you all think.

The 2016 presidential election has us asking hard questions about the legitimacy and future of democracy. Perhaps those of us who see the trend should change our orientation toward democracy and political belief.

As dismal as things seem, all this does have one rather hopeful implication. Our situation is reminiscent of what political philosophers call the “state of nature,” a hypothetical time before the dawn of politicians when people had the perfect freedom to do whatever they pleased. The trouble with this set-up is that people in such a situation lived with a great deal of fear that their property would be stolen and their accomplishments spoiled by nefarious neighbors. This thought experiment is a premise in an argument for a certain type of government: We know we have to cooperate with others; we know we cannot live as an island unto ourselves. And all these community relationships make us vulnerable. According to sages of the liberal tradition, we should happily accept at least a minimal government to protect our ability to do whatever we find meaningful up to the point where we would use that freedom to keep others from doing whatever they find meaningful.

In the realm of beliefs—the actual realm, not a hypothetical one— things are not much different. We are largely on our own when it comes to what to believe. We have yet to enter the age of somatic enhancement and thought crimes, and so we have the perfect freedom to believe as we please. But as in the state of nature, we have to rely on one another. We cannot all be doctors and chemists and scientists and mathematicians and writers and economists. And we cannot make significant progress in any of these areas without extensive collaboration.

Even for everyday beliefs about the weather and community events and tragedies across town, we have to rely on others. Whether the others are CNN, Huffington Post, the Republican Party, OccupyDemocrats.com, your college chemistry textbook, the IRS, your attorney, your pastor, your friends, your parents, Jane Doe’s blog, etc., our information about the world around us is largely second-hand.

And also like the political state of nature, some want to steal, not our freedom to think and learn, but our ability to do it well. They want to harness our efforts for their own ends. Some of our sources have an interest in getting things right or, at least, fact-checked. Some sources have conducted experiments. Yet what we read is, in influential ways, the product of “sharpening and leveling,” which means you get the version of the story they think you need emphasizing what they think you should hear. Even when the intentions are virtuous, the story is distorted. And we have evidence that intentions are not virtuous. The distortion increases and becomes entrenched as your distance from the information and the source increases, as memes are disseminated, as search algorithms selectively filter content, and the responsibility for what is presented decreases. Some have called this a “post-fact” society.

Just as a muscle-bound thief in John Locke’s state of nature could steal your property and leave you in fear that he will return for your life, pundits, politicians, and internet trolls quietly sneak away with the reliability of your rational faculties. They lull you into a sense of knowing something even while they give you the sense that you’ve done your “research.” You genuinely believe you’ve gone to professionals, experts. Their presentation mimics the presentation of reliable sources, and you are left doubly dulled.

W. K. Clifford, in “The Ethics of Belief” (1877), wrote that good belief forming practice can be disheartening because, “It leaves us bare and powerless where we thought that we were safe and strong.” But ultimately the payoff is worth it because the resulting beliefs are likely to be good ones. Fake news does something nefarious: It leaves us bare and powerless while making us believe we are safe and strong. Exciting headlines turn out, on closer inspection, to be speculation or gross overstatement. Filtering software gives the illusion that you are well-informed on all-sides of a debate.

In “What is Enlightenment” (1784), Immanuel Kant wrote that people remain unenlightened because of laziness and fear. There is still some truth to this. But we now face the additional trouble of non-experts who purport to be experts or convincingly mimic experts. The energy and skill required for believing responsibly may be higher than ever before.

Can anyone save us from this epistemic state of nature? Didn’t I say there is something hopeful here?

The hopeful bit is that it is now clear where the ley lines of responsible belief fall. We can know very little, and the burden falls on us to know that little bit well. Unlike the political state of nature, we cannot enlist elected officials to help us navigate the evidence. They have their own interests to promote (consider the milk controversy). They are subject to the same fallacies and biases as the rest of us. For everyone (politicians, news outlets, pundits, etc.), we have to ask--we ourselves must ask: Have they done their homework? Can they use that information well? Can they use it in ways that protect our interests? What makes someone an expert? Is this person an expert about this topic?

Since, we have good reasons to suspect that very few people use information well, we are now freed to employ our energies elsewhere. We can focus on which speakers are experts about what rather than trying to decide which news outlets are the least biased. We can learn to look for the sign posts of expertise beyond the graphic designs and ideologies. The burden is on us to believe only when believing is the responsible reaction.

This is where adventure begins. We still have to rely on others—doctors, lawyers, accountants, scientists—but we understand that there is hard work to be done to find responsible ones. And no one can take over that job for us. We are no longer beholden to Fox News or MSNBC, and if we want our beliefs to be responsible, we cannot outsource our beliefs to them, either. We know our energies are better spent elsewhere—where they matter.

​The 2016 presidential election has us asking hard questions about the legitimacy and future of democracy. We are questioning--yet again—the prudence of an Electoral College. We are reminded of voter irrationality. We are debating who is to blame for giving racism, misogyny, and xenophobia a platform from the highest office in the land: the poor? the media? racists? Some are even questioning whether we can persist in disciplines that seem so impotent in face of political power.

But even disciplines that aren’t questioning their legitimacy, like political science and economics, face the problem of inertia. Suggestions for how we might enhance or eclipse traditional democracy are met with horror. The right to vote is twisted shamelessly into a duty to vote. Advertisements shame anyone who chooses not to participate in a system that some have argued is itself immoral. The two-party system has become a self-perpetuating trap of anti-intellectual rhetoric.

This isn’t to say there aren’t important proposals on the table. We might, as Sarah Conly (2013) suggests, get over our love-affair with autonomy and start unapologetically restricting the freedom to engage in what social scientists consider “harmful” behavior. Or we might continue softer efforts already underway, changing not which choices are available, but the structure of those choices (Richard Thaler and Cass Sunstein, 2009), and England has seen significant increases in tax revenues using this approach. We could also increase access to political participation, as Beth Simone Noveck (2015) suggests, increasing transparency in policy-making and including a wider array of informed citizens in the decision-making process. More radical still, we could ditch democracy for something better, along the lines of what Jason Brennan (2016) suggests, giving more weight (or more votes) to better informed citizens.

Of course, each of these proposals faces serious objections and overwhelming social obstacles. And the likelihood that any one of them would convince a majority of Americans to change the way they understand American politics is, frankly, inscrutably low. And so, maybe there aren’t live prospects for serious change. Maybe the current U.S. system is the best the U.S. can hope for. What then?

If that’s right, then perhaps we should stop playing big politics altogether. There are two problems with political decisions in contemporary democratic republics: (1) voters are uninformed and (2) there is little access to vehicles of political change.

Problem 1 is that everyone—citizens and politicians alike—make poor decisions, both for themselves and for others. We don’t know what’s good for us, and even when we do, we don’t reason well about it. We are easily taken in by fallacies, cognitive biases, heuristics, and social biases. And most importantly, politicians are no less subject to poor reasoning than anyone else. Even apart from political pressures to behave selfishly, the people we hire to make decisions on our behalf are no better at making decisions than we are, and are no more likely to take experts seriously except when they serve their interests.

Exacerbating this problem, the causal connections between laws, regulations, and the real world are so tenuous that it is difficult (even for policy experts) to discern which are effective for which outcomes. There are no experimental controls for public policies. We get one shot under one set of experimental conditions.

And whether because of political pressures or a naiveté to confirmation bias, politicians are happy to tell us that the good things happened because we voted for them and the bad things happened simply because of bad luck or the other team. Political rhetoric appeals to all those seedy places in our minds that tempt us for all the wrong reasons. The Devil appears as an angel of light, as the old text says.

Problem 2 is that people lack access to mechanisms of political change. Consider that citizens are legally excluded from almost every political process except voting (see Noveck, 2015). And the options on which we vote are chosen and framed behind closed doors by those with a vested interest in preserving the control vested in their positions. Only the odd activist campaign catches the interest of politicians, and then only to be recast and oversimplified to solidify constituents and used as ammunition against opponents. Further, our votes are so filtered through state rules and the Electoral College, and their mathematical impact is so insignificant, that voting for a candidate is about as effective as cheering for a sports team from the stands. We are not the ones with the power, and we have virtually no chance at changing the rules of play. We have no more influence over political institutions than fans have over draft picks.

But this is no call for anarchy. Even without a formal political state, the desire to preserve our interests would likely lead us to create social institutions not appreciably different from formal political states (see Nozick, 1974). And this is not a call for libertarian minimal government. It is so easy to want those in power to come to our aid, that any trend in that direction would likely be reversed in subsequent election cycles.

Instead, this disconcerting state of affairs suggests something altogether different from a political solution, though perhaps no less radical. It is a call only for those who recognize the depth of this problem to change their orientation toward democracy and political belief.

A hot trend in rhetoric around the presidential race is fact-checking. I assume the idea is that if one candidate says more objectively true things, that politician is more trustworthy, and therefore, the better candidate. And while that might be true if fact-checking could reliably reveal all the relevant forms of false information, a quick review of rhetorical strategies shows that it cannot.

Politicians have a number of handy tools for avoiding the truth that do not involve outright lying. Before Donald Trump flushed any pretense of civility, it was bad etiquette to make outright false claims in public speeches. In 2015, former speechwriter Barton Swaim wrote that, “[O]ne hears very few proper lies in politics.” But even without proper lies, politicians were not trustworthy. Swaim notes that “[u]sing vague, slippery, or just meaningless language is not the same as lying: it’s not intended to deceive so much as to preserve options, buy time, distance oneself from others, or just to sound like you’re saying something instead of nothing” (The Speechwriter: A Brief Education in Politics, 2015: 28).

Swaim details at length the tactics he was asked to use during SC governor Mark Sanford's governorship, from sentence lengtheners to blatant red herrings. In a more recent piece for The Washington Post, Swaim writes, “This is what gives political discourse that distinctive air of unreality. Its language isn’t intended to persuade as you and I would try to persuade each other; it’s intended to convey impressions and project images and so arouse the sympathies of voters” (“Why Do So Many Politicians Sound Like Robots?” Feb. 2016).

It turns out that the problem with political rhetoric is not that it is difficult to tell which politicians are telling the truth and which aren’t, it is that none of them are, with different degrees of artistic flourish. Political rhetoric is not (and arguably has never been) about helping citizens form responsible political beliefs; it is about garnering support and unifying a voting base. This means that fact-checking, however entertaining, cannot help us vote better. Here are three ways politicians evade the truth.

In addition to making explicitly false claims, politicians dissemble by not answering questions and by using vague, emotionally charged language. If a politician were to say that she has “supported policies that have helped the poor,” it is difficult to say how we might fact-check that claim. What does she mean by “help” the poor? How do we know the causal effects of any particular policy? What does she consider poor? Consider that economists are divided on the effect of minimum wage laws. Some argue they are necessary to protect the lowest socio-economic groups, while many argue that eliminating minimum wage laws would actually help the lowest quintile by expanding their employment opportunities and preserving jobs. Given this sort of disagreement among experts, whether a politician supports or opposes minimum wage laws, he or she can claim—with a straight face—to support policies that help the poor.

Further, politicians make promises they have no intention of keeping, either because they are not interested in keeping them or because they are not within the purview of their office. For instance, politicians who promise to reduce government spending know that 60% of the U.S. budget is mandatory and only about 34% is discretionary. And because Congress plays a large role in budgeting, the amount that any government official can influence the federal budget is extremely low. Such promises are lying promises, intentionally deceptive. And since fact-checkers cannot fact-check the future or a speaker's intent, lying promises go undetected.

To be sure, not all unfulfillable promises are intentionally deceptive; some are simply made in ignorance or arrogance. Politicians do not know much of what the U.S. President can and cannot do until they are in that role. That is because information about what options are open to the president is kept confidential, usually on grounds of national security (see Beth Simone Noveck, Smarter Citizens, Smarter State, 2015). Plus, circumstances change in ways that prevent some promises from being fulfilled. Thus, politicians make ignorant promises. For instance, Obama vowed to close the prison at Guantanamo and to eliminate our dependence on oil from the Middle East. Did Obama make these promises with the intention not to keep them? We could never know, but it is quite possible that he just didn’t know what he could accomplish in these areas, either because he didn’t yet know what options were available to him as president or because subsequent events prevented him from being able to fulfill them. But again, neither Politifact nor FactCheck.org could help us decide whether Obama was trustworthy when making such promises.

Someone might object that fact-checking can at least help us form the responsible belief to be skeptical of political rhetoric. But fact-checking can’t even do this. Since it cannot detect the deception in dissembling, lying promises, or ignorant promises, its results are biased against those who make explicitly false claims. Thus, relying on fact-checkers can suggest one candidate is more trustworthy than another simply because one makes explicitly false claims and the other speaks in vague generalities.

If all this is right, public debates and political rhetoric are useless guides to responsible political belief—they are masochistic entertainment, an opportunity (not unlike sports fandom) to wave our values as flags and get our blood boiling with indignation. If you want responsible political beliefs, then it seems you are left to your own devices.

Being left to our own devices means we are all in what I call the “epistemic state of nature.” As in the famous thought experiment of a political state of nature, we can enlist the help of others in forming our beliefs, but we are on our own in deciding whom to trust and to what degree. But unlike the political realm, we cannot set up a public trust to protect us from irresponsible belief. Since all political commentators have one agenda or another, deceptive and misleading language is ubiquitous. This is a reason to be skeptical of political rhetoric. It should force us to ask what political beliefs are worth taking seriously. Which ones can I test? Which ones actually affect my life?

In my forthcoming book, Winning Votes by Abusing Reason (Lexington Books), I argue that responsible belief requires, not only a great deal of energy and skill in evaluating evidence, but the ability to recognize when exerting that energy is worthwhile. Having a responsible belief is more than simply having good evidence; it also requires an interest in truth, a humility to interpret that evidence charitably, and the courage to change your beliefs when the evidence doesn't favor them. But you would not muster these character traits when deciding on which movie to see or which route to take to work. The costs of deciding poorly are low. And you wouldn't muster them to argue about whether Pluto should be a planet. They payoff for being right is surely low. We put energy into believing when value of the belief (the payoff) is comparable to the value of the energy it takes to be right.

It is easy to be flippantly arrogant about which football team will win a game. Nothing hangs on being right. It is easy to be flippantly arrogant about immigration policy because what consequences are there for being misinformed or mistaken? On the other hand, if your livelihood or friendships or marriage depended on being right about something, you might put more effort into that belief (though this motivation is reduced when the consequences are not immediate: consider retirement savings, college savings, eating well, etc.).

I argue that the energy is only worthwhile when applied in contexts where it has tangible effects. Since political beliefs have few tangible effects, voter ignorance remains high. To believe responsibly, we need feedback mechanisms that benefit us when we are right and harm us when we are wrong. This means that the most responsible political beliefs will be those that influence decisions in the short-term, in local, voluntary organizations. Without such mechanisms, political rhetoric is no better than horoscopes. I may believe that “an important change is in my future,” but the idea that it is grounded in anything like reality is little more than dogmatism.

[Winning Votes by Abusing Reason: Responsible Belief and Political Rhetoric (Lexington Books) will be available December 2016.]

Recently, I have been working with the Center for Ethics at MedStar Washington Hospital Center in D.C. to develop a series of workshops on moral distress for respiratory therapists. Moral distress (MD) is the phenomenon where you believe you know what morally ought to be done, but you are prevented from doing it because of institutional, relational, or professional constraints. The phenomenon was first identified among critical care nurses about three decades ago, but it is clear that it affects everyone in the clinical setting, including physicians, social workers, physical/occupational therapists, and especially respiratory therapists.

Respiratory therapists (RTs) are the people who help you breathe when you have trouble doing it on your own. And often, they keep you breathing when you can't. They work in a variety of acute care settings, including emergency departments and trauma centers, and they are among the lowest in the medical hierarchy. They see a lot of pain and tragedy. They see the unfortunate results of bad medical decisions, whether on the part of physicians, families, or patients. These cases are certainly emotionally distressing, but they aren't necessarily morally distressing.

Distinctly moral distress occurs when RTs see pain they could alleviate but are prevented from doing so because the medical team hasn't yet decided on a plan of care, or because family members are undecided what their loved one would want. Sometimes there is disagreement among family members about a treatment option or between surrogate decision-makers and the medical team. And sometimes surrogates choose an option that means more pain for the patient even when it isn't necessary. Whatever the source of tension, if it includes respiratory problems, RTs are often present. They are at the bedside when others get to review a chart from afar. They see things that doctors and nurses do not, yet they are rarely included in medical team meetings and even more rarely invited to contribute to meetings with families. The distress that results from working in these predicaments is distinctly moral: they see what could be done to improve a patient's well-being, but they are prevented from doing so.

​The result of MD is burnout. RTs avoid work. They change hospitals. They get out of the profession altogether. Happily, there are people working hard to help RTs understand and reduce their moral distress. This research is growing steadily in the field of nursing, but only recently have researchers directed their attention to RTs.

What helps? From the little we know right now, standard methods for dealing with emotional distress help some: seeking social/pastoral support, talking with loved ones, writing exercises that facilitate emotional healing, etc. But these strategies are limited to grin-and-bear-it results, which can simply put off burnout. To address the problem more comprehensively, the Center for Ethics at MedStar is working on a three-step educational model: (1) help clinicians understand the unique nature of MD, (2) give them the terminology to express and discuss MD with peers and superiors, and (3) create an institutional environment open to preventive measures, such as ethics consultation services and policy recommendations.

In the workshop last week, I led a group of respiratory therapists in a discussion of different types of normative constraints (social, legal, moral) and the types of values associated with them (preferable, permissible, required, etc.). We applied these concepts to cases to tease apart different types of distress, and at the end, I offered some strategies for dealing with them.

Soon, we hope to obtain grant funding to evaluate the effectiveness of the instruments we've developed so far. In the meantime, it is encouraging to be welcomed to discuss philosophy with people who face tragedy every day.